29th April 2024

A 55-year-old woman presents with a 6-month history of widespread bone pain, particularly in her hips and lower back.

A 55-year-old woman presents with a 6-month history of widespread bone pain, particularly in her hips and lower back. She reports feeling fatigued and has difficulty getting up from a chair or climbing stairs. She has a history of bowel resection for Crohn’s disease 10 years ago. On examination, there is tenderness over her pelvic bones and lumbar spine.

Investigations:

Serum calcium: Low

Serum phosphate: Low

Alkaline phosphatase: Elevated

25-hydroxy Vitamin D level: Significantly low

X-ray of the pelvis and lumbar spine: Looser’s zones and reduced bone density

Which is the most likely diagnosis?